How do you work thru practice questions from HELL!

[NCINDASUN]

I'm still plugging away at practicing questions. Some of them drive me crazy! For example:

A client who has clear lung sounds and unlabored breathing is receiving aminophylline IV. Which of the following would be the MOST appropriate nursing action if the client's IV infiltrates?

A) Apply warm soaks to the infiltration site, start an new IV, and continue IV medications. Didn't seem like a good plan

B) Wait two hours, reassess the client, and restart the IV if the client has wheezing or labored breathing. That's a no. Can't just stop and not tell Dr.

C) Restart the IV and contine the previous medication schedule. Sounded good to me as long as you use a different site

D) Call the physician and recommend that the IV medication be changed to PO. My first thought: If the Dr. wanted IV, why would I challenge that?

Turns out D is the answer, BUT: Davis says IV aminophylline should be avoided but if extravasation occurs, give local injection of 1% procaine and application of heat may relieve pain and promote vasodilation. So by this intervention A is also true.

How the heck am I supposed to work through a question like this? I can't win!

[Immortal_us]

But regardless if the iv is infiltrated they are stating the client is stable bc respiration are fine lungs sounds are fine. The part that states iv infiltration should be disregarded because it is not about the iv.

[NCINDASUN]

But regardless if the iv is infiltrated they are stating the client is stable bc respiration are fine lungs sounds are fine. The part that states iv infiltration should be disregarded because it is not about the iv.

I know I am beating a dead horse :deadhorse but that's part of the trouble I'm having here.

What if the question read "Anthrax patient, no signs of distress, infiltrated IV" Just because the symptoms are gone doesn't mean that the meds should be stopped/changed.

If it comes down to knowing the details of all the drugs, not just the side effects/adverse reactions, I'm scr@wed.

One day and counting....Heavy sigh....

[Leda]

NCLEX questions can be frustrating, however they are written to assess the ability of the candidate to apply safe and effective nursing care. In order to do this, the candidate (test-taker) has to apply all of the concepts they've learned to the situation in the question and the responses. It is also important to remember, that in NCLEX "speak" you are being asked to select the BEST answer from those available. This can be different from what you consider to be the correct answer. The best answer is based on the principles of safe and effective care.

Using your question, here is an example of how you would determine the best answer:

"A client who has clear lung sounds and unlabored breathing is receiving aminophylline IV. Which of the following would be the MOST appropriate nursing action if the client's IV infiltrates?"

The nurse will assess that this patient's respiratory distress has resolved and apply the knowledge that IV aminophylline is typically administered for symptomatic patients. This observed changed in status (clear breath sounds) warrants physician notification so that the physician can reconsider pharmacological therapy. The infiltrated IV is the prompt for the nurse to make a determination considering the patient's need for continued IV aminophyillne therapy. The nurse would then share this assessment with the physician (collaboration of care) and the MD would change the order if warranted.

Next to select the best answer you can go through the possible responses and apply the principles of safe and effective care.

A) Apply warm soaks to the infiltration site, start an new IV, and continue IV medications. The key point, from an NCLEX perspective is that the nurse needs to recall that a physician's order is required for the application of heat or cold (safety issue and scope of practice). Therefore even if a warm soak is necessary, the nurse must obtain an order to do so. (It is not considered to be an independent nursing action). Therefore this can't be the best answer.

B) Wait two hours, reassess the client, and restart the IV if the client has wheezing or labored breathing. It is inappropriate to delay care, if the nurse determines that this patien'ts condition may deteriorate, then the nurse should not wait until the patient is symptomatic to gain IV access.

C) Restart the IV and contine the previous medication schedule. Not the best answer for the reasons stated previously. Remember the nurse has assessed the patient's condition as improved, therefore it is likely the patient does not require IV med any longer. Remember an IV is a source of infection for the patient (safety issue). In other words reinsertion of the IV is based on a risk-benefit, the risk of having an IV (complications of IV therapy, as well as IV aminophylline therapy) in this instance is greater than the benefit the patient would obtain from the aminophylline.

D) Call the physician and recommend that the IV medication be changed to PO. Best answer, for the reasons stated previously.

Hope this is helpful. Best of luck on the NCLEX.

[HyperRNRachel]

See what I mean? So many ways of looking at the questions. I appreciate Suzanne's reminder of the collaborative effort. The way D is written, there is no mention of stopping the infiltration. We were taught to never assume anything and that the answers had everything you needed in them.

Two days and counting. Heavy sigh.....

Two days and counting? I hope you are putting away all the books, flashcards, notes, CD's and websites tomorrow. You need to pack it away and relax all day on Wed. ..............think of it as allowing all the information to implant itself in your brain.

You will be fine. Put on your boots and go kick some NCLEX booty.

[oldnurse newnurse]

I choose answer c but I see the error in my ways now.